Wednesday, September 16, 2009

Early Testing for Alzheimer's Disease

One of the most important aspects of dealing with Alzheimer’s is early detection. Early diagnosis of Alzheimer’s has many advantages to the victim and their families, allowing for opportunities to deal with the physical, mental and emotional effects of Alzheimer’s disease. With Alzheimer’s, knowledge is power. Knowing and recognizing the symptoms of Alzheimer’s is the most effective way to deal with experiences of memory loss, behavioral shifts, confusion and other symptoms when they happen. When Alzheimer symptoms become identifiable, they are less frightening for family and friends. Once accepting of Alzheimer’s, early diagnosis allows patients and family to build the best medical team for their case, and also makes available current and experimental drugs and treatments for Alzheimer’s disease.

Alzheimer's disease is diagnosed after other conditions are ruled out. If you are suffering from a decline in mental abilities (dementia), your doctor will attempt to find out if another treatable condition may be causing those symptoms.
  • It is very important to rule out delirium as a possible cause of symptoms, especially if the symptoms came on suddenly rather than gradually. Delirium may require emergency medical attention.
  • Symptoms of confusion and memory loss can sometimes be caused by depression. Depression is very common among older adults, but it is sometimes difficult to recognize. It may be successfully managed with medicine and counseling.
Upon appearance of symptoms of Alzheimer’s, one must find a doctor that the patient and family feel comfortable with. While there are no specialists in Alzheimer’s, The American Alzheimer Association can help with finding doctors who are knowledgeable and comfortable with the Alzheimer’s disease. These doctors might also refer patients to neurologist, psychiatrists or psychologists who specialize in mental function and can quickly detect and diagnose Alzheimer’s.

There is no single test that proves someone has Alzheimer’s. Rather, the medical workup for Alzheimer’s is designed to evaluate overall health conditions and identify mental problems.

Alzheimer's disease is diagnosed with a medical history and a physical exam. A physical exam is used to help find out if a physical problem may be causing a person's dementia symptoms. It may be possible to correct some of these problems. For example, sometimes a simple hearing or vision problem can cause confusion, social withdrawal, or a change in behavior, such as hostility or unresponsiveness. The person may have an undiagnosed illness or infection that is causing the symptoms.

Estimates show that a regular physician can diagnose Alzheimer’s with 90 percent accuracy, and even if they can only divulge it as dementia, a brain specialist can certainly identify Alzheimer’s. Be prepared to tell your doctor when Alzheimer’s symptoms started, how often and how severe they are, as this will help determine the stage of Alzheimer development. Interviews with family members are standard when diagnosing Alzheimer’s disease and medical history of relatives will be thoroughly examined.

Also, complete physicals and diagnostic tests are very common in order to identify if other disorders are causing Alzheimer symptoms. Brain imaging has also revolutionized the way doctors can look at and map the brain. Typical Alzheimer’s work-ups involve magnetic resonance imaging (MRI) and sometimes computed tomography (CT). Also, positron emission tomography (PET) and function MRI maybe employed in order to reveal how brain cells in various regions are working through their use of sugar or oxygen.

  • Magnetic resonance imaging (MRI). An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into the tube-shaped MRI machine, which makes loud banging noises during scans. The entire procedure can take an hour or more. MRIs are painless, but some people feel claustrophobic in the machine.
  • Computerized tomography (CT). For a CT scan, you lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images, or slices, of your brain. The test is painless and takes about 20 minutes.
  • Positron emission tomography (PET). During a PET scan, you'll be injected with a low-level radioactive material, which binds to chemicals that travel to the brain. You lie on a table while an overhead scanner tracks the radioactive material. This helps show which parts of your brain aren't functioning properly. The test is painless and can be particularly useful in distinguishing between different types of dementia.

Note that some people with dementia have a condition that proper treatment can reverse (unlike Alzheimer's disease). Lab tests may be done to rule out other possible causes of a person's symptoms, such as levels of certain minerals or chemicals in the blood that are too high or too low, liver disease, abnormal thyroid levels, or nutritional problems, such as folate or vitamin B12 deficiencies. Treatment for these conditions may slow or reverse mental decline.

When assessing mental function and Alzheimer’s risk, often doctors will recommend the mini-mental state exam (MMSE) which tests the patients’ range of everyday mental skills. Sample questions include but are not limited to:
  • Remember and repeat a few minutes later the names of three common objects.
  • State the year, season, day of the week and date
  • Count backward from 100 by 7s or spell “world” backwards
The maximum MMSE score is 30 points. A score of 20 - 24 suggests mild dementia, 13 - 20 suggests moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer’s disease declines about 2 - 4 points each year.

Another Alzheimer’s test used is the “mini-cog” which includes two tasks: 1) remembering and a few minutes later repeating the names of three common objects, and (2) drawing a face of a clock showing all 12 numbers in the right places and a time specified by the examiner. Both tests are good indicators of mental capacity and can reveal symptoms that might overlap with dementia and Alzheimer’s disease.

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